Women’s Preventive Services Needed in Health Insurance

The process of implementing the new health care law continued last week as a panel of independent experts meet to begin to develop evidence-based preventive health guidelines for women that will be used to determine what preventive services will be covered in all new health insurance plans and provided with no cost-sharing.

Under a part of the new health care law that went into effect in September, all new insurance plans are required to cover certain preventive measures like mammograms, pap smears, smoking cessation therapy and folic acid and provide them to patients at no cost. To supplement these new rules, the Institute of Medicine has been tasked with addressing serious gaps in the definition of preventive care for women and ensuring that this landmark protection meets the full range of women’s health needs. This week the Institute of Medicine’s panel of women’s health experts is holding its first meeting to begin the process of making preventive care more accessible and affordable for women.

As a part of this meeting, I testified before the panel and discussed general barriers to care that women face and recommended five services that the panel should be sure to include in their final recommendations to Department of Health and Human Services (HHS).

Women seeking affordable health care face significant and unique barriers. Women generally make less than men. With women making on average just 78 cents for every dollar a man earns, women have less money to spend on their health care. It is then not hard to imagine why more women than men have faced economic hardship due to health care needs. Women are also more likely to delay or avoid seeking care, including preventive care, due to cost. Evidence also suggests that even moderate co-pays can cause individuals, especially those with low and moderate incomes, to forgo needed preventive care.

As NWLC has shown, before the Affordable Care Act, the individual insurance market routinely failed women, making access to affordable health care even more challenging. Women obtaining identical plans to men oftentimes pay higher premiums. To add insult to injury, maternity care is rarely included in basic individual plans, and as a result women must purchase a supplemental policy to cover pregnancy. These riders can be prohibitively expensive. Women who obtain coverage through an employer are partially protected from these barriers due to federal and state employment discrimination laws, but cost and coverage challenges continue to exist.

The National Women’s Law Center also proposed five additional services to be included in the final list:

Family Planning Counseling and All FDA- Approved Prescription Contraceptive Drugs and Devices- Nearly all American women use contraceptives during their reproductive years. Family planning counseling and supplies allow women to control the spacing, timing and number of births, which leads to improved health and mortality outcomes for women and their children. The ability to plan a pregnancy can prevent a range of pregnancy related complications that can endanger a woman’s health, and allows women to the take the necessary steps to ensure her own health is adequate to undergo pregnancy and childbirth.

A wealth of information supports the recommendation that reversible and permanent forms of contraception be covered by health insurance.

A consensus study by a panel convened by the IOM in 1995 to address unintended pregnancy recommended that financial barriers to contraception be reduced by “increasing the proportion of all health insurance policies that cover contraceptive services and supplies…with no copayments or other cost-sharing requirements, as for other selected preventive health services.”

The Centers for Disease Control and Prevention named family planning one of the ten most important public health achievements of the 20th century because of its contribution to “the better health of infants, children, and women.”

Contraceptive use is one of the cornerstones of Healthy People 2010, the nation’s agenda for promoting health and preventing disease.

The National Business Group on Health, a non-profit organization representing large employers’ perspectives on national health policy issues, conducted a comprehensive review of available evidence and recommends a clinical preventive service benefit design that includes all FDA-approved prescription contraceptive methods at no cost-sharing.

Including family planning counseling and supplies in the final recommendations would also build on key federal protections in place for millions of women. For almost 40 years, Medicaid has covered family planning services and supplies and provided them without co-payments for millions of low-income women.

Because the only FDA-approved prescription contraceptives available today are for women, and pregnancy is a condition unique to women, the panel has the opportunity to rectify a long-standing inequity for women. Failure to cover contraceptives forces women to bear higher out-of-pocket health costs, totaling approximately $9,000 over her lifetime. Nearly ten years ago, the Equal Employment Opportunity Commission issued an interpretation of the federal civil rights law that prohibits discrimination in employment, stating that it is sex discrimination for employer-sponsored health insurance plans to provide coverage of other prescription drugs and preventive services, but fail to provide coverage of contraception.

Screening for Intimate Partner Violence- Three women are murdered each day by their husbands or boyfriends, and two million injuries result from domestic violence each year. We should be using every tool at our disposal to identify and help victims of intimate partner violence and we believe routine behavioral assessment for intimate partner violence could help reduce these numbers.

Screening for Cervical Cancer- Cervical cancer was once the leading cause of cancer death for American women, but screening and early intervention has greatly reduced the number of deaths each year. It has been a several years since the United States Preventive Service Task Force (USPSTF) has updated its recommendations. We urge the panel to review relevant evidence to ensure women are receiving the appropriate care.

Breast Pump Equipment- Studies have shown that breastfeeding provides important long-term health benefits for mothers. Lactation supplies, including breast pumps, are critical for mothers to sustain breastfeeding and receive the preventive health benefits that lactation affords.

Physician-Recommended Preventive Services- Many of the services that are provided in a routine preventive visit are included among USPSTF recommendations, yet the Task Force does not recommend the actual visit itself, and women are often charged co-payments at the time of service. We urge the panel to consider covering all well-woman and preconception care visits. When a doctor recommends a preventive health visit, a woman’s decision about whether to comply should not turn on her ability to afford the care.

A number of organizations, including the U.S. Conference of Catholic Bishops, decried the possibility that contraception may be included among the preventive health services covered, but this extreme position is without merit and harmful to women. Sound science should trump ideology, and we’re confident that the Institute of Medicine panelists will not let the religious views of some interfere with their expert review of the scientific and medical evidence and the needs of American women.

Overcoming Disparity – Women’s health damaged by increased city living

Today’s urban cities are suffering from a dramatic rise in a disproportionate health crisis coming from its poorest citizens, finds WHO (World Health Organisation)/UN-HABITAT report, Hidden Cities – Unmasking and Overcoming Health Inequities in Urban Settings. Women suffering under poverty are especially sensitive to impacts of urbanisation as statistics show women in densely populated areas have a 1.5 times higher rate of HIV/Aids than men. Women in cities also face higher dangers of contracting Aids, a figure almost twice as high as their rural sisters.

On the edge of the global economic shakedown, as numerous cities and urban areas suffer from rising population, women who suffer from poverty experience greater encounters with overcrowded substandard housing, infectious diseases, food and water safety issues, inadequate sanitation and increasing solid waste disposal problems.

“In 2010, more than half (the world’s population) live in cities, and by 2050, 7 out of every 10 people will live in urban areas,” outlines the new report. “Most of this explosive growth is occurring in developing countries, where municipalities and other government authorities are often overwhelmed by the rapid population boom.”

With the transfer of both men and women from rural to urban regions steadily increasing at a rate of 60 million per year, globalisation is reaching a tight squeeze creating a real possibility that massive problems in overcrowding will overshadow our next century. Urban city dwellers will most assuredly face failures with services and infrastructure creating dire consequences that may outlive generations.

For the very first time in history, a majority of the world’s populations are living in cities. And this figure is rising. Ultimately, the problems of urbanisation will affect the life and health of rich and poor alike, but the poorest populations will suffer much more from inequities.

Developing nations, spurred by increasing problems of climate change, are also growing the world’s largest slums, as the rural poor break with generations of steady work in agricultural endeavors to move to cities under mythological promises of better employment.

“Urban poverty has become highly feminised,” says the new WHO/UN-HABITAT report. Women, who have worked in farming agri-industries, find that upon their arrival to urban areas they are often quickly and sharply excluded from jobs, denied training programs and placed in situations that bring ongoing and demeaning exclusions.

While cities offer rural women new experiences and opportunities to create larger support networks, they also face heightened struggles toward empowerment. With urban environments come increased dangers of violence to women due to domestic and economic struggles at home. Rape too is an ominous urban threat.

“In many cities, the urban poor face challenges in accessing health services due to their inability to pay out-of-pocket expenses for services,” says the 2010 report on urban health inequities from WHO/UN-HABITAT. “This is in contrast to rural settings, where the main access issue facing residents is that health facilities are far from their homes and communities.”

In Bangladesh, surprisingly the number of women who have diabetes increases as the nation becomes more developed and more urbanised as wealthier women, 45yrs and older, outnumber poor women who have the disease. But care, for those with less money who do suffer from diabetes, is markedly unequal.

“Many urban dwellers at some point will face a dire choice: either to go without essential treatment, or to seek treatment and go into poverty,” continues the WHO/UN-HABITAT report.

Health equity, for urban and non urban women, is an issue that relates across the board stating that all woman must have fair and equal access to health management and programs.

“Opportunities to put health at the heart of the urban policy agenda exists, and it is time for all sectors to work together toward innovative and effective solutions that mitigate health risks and increase health benefits,” says Margaret Chan, director of WHO.

“Of the many risks to health that are linked to rapid urbanization, none is more compelling than urban poverty,” adds Inga Björk-Klevby, assistant secretary general of the UN and officer in charge of UN-HABITAT.

“These unfair health gaps are growing in spite of unprecedented global wealth, knowledge and health awareness,” continues the UN assistant secretary general.